Pathology: A Key Link in the Cancer Care Cycle

Curtis Stratman

Pathologists are a critical part of cancer care teams, yet many patients know nothing about the role pathologists play in diagnoses and subsequent treatments. Furthermore, healthcare trends threaten to make it even more difficult for pathologists to engage with patients and other specialists.

Pathologists are responsible for making the definitive cancer diagnosis. They view the tissue from a biopsy. They evaluate it in the context of a patient’s medical history. And they make the assessment that becomes the foundation of an oncologist’s recommended treatment plan.  This definitive diagnosis is not generated through a computer or other analytical device. The pathologist looks at each sample individually under a microscope and renders an opinion.

The work that a pathologist does in the lab influences the full scope of cancer care that follows, which for many patients can involve years of treatment. Despite the gravity of some diagnoses, many patients will never meet their pathologists. They will know little, if anything, about the process or the expertise that went into developing that initial diagnosis. Often, the communication between the patient’s oncologist and pathologist will be done solely through written documents.

If a patient is unaware of the role that pathologists play in cancer care, he or she can miss opportunities to participate in their own healthcare. A survey performed by the Wall Street Journal and Harris Interactive showed that 29% of Americans had family members that sought a second medical opinion in the previous five years1. Cancer patients are especially likely to do so because of the high-stakes nature of the disease. Those second opinions, however, are often done by visiting another oncologist. Seeking a second opinion of the pathology diagnosis from a specialist in their cancer type is an option which they may not be aware of.

For care teams to leverage the full potential of a pathologist’s expertise, they should be aware of both the role that pathologists play and the challenges that pathology, as a practice, faces. Struggling with being disconnected from digitally collaborating with the cancer care team, pathology is also facing pressure from troubling healthcare trends.

The World Health Organization expects that annual cancer cases will rise from 14 million in 2012 to 22 million within the next two decades.2 Cancer is the second leading cause of death in the United States, just behind heart disease.3 Beyond the loss of life, cancer’s financial costs are significant, representing the highest economic loss of all 15 worldwide leading causes of death. In 2008, for example, the cost of premature death and disability (but not direct medical costs) from cancer was $895 billion worldwide, compared with $753 billion for heart disease.4 As cancer rates rise, the costs of care are expected to rise as well, creating a serious economic challenge for the healthcare industry.

Meanwhile, the College of American Pathologists projects that by 2030, the pathology industry in the United States will see 17,600 full-time equivalents fall to 14,000.5 Pathologists will be faced with a larger volume of cases and will have fewer team members to read them.

Complicating this situation even further is another unfortunate reality: pathology as a practice has not fully realized the potential of information technology advancements. Where digital technology has transformed virtually every other field in medicine—like urology, cardiology, and radiology—many pathologists are still using traditional microscopes and managing physical case files.

Elevating the role of pathologists—making their contributions to cancer care visible and accessible—will require two shifts:

1)      Patients need to be empowered so that they can ask the right questions about their diagnoses.

2)      Pathologists need more advanced tools so that they can more easily participate in care teams and provide more precise diagnoses while also coping with the burden of increasing cancer cases.

The insights that pathologists add to the care team are integral to effective cancer treatments. The full spectrum of stakeholders—from patients to healthcare leaders—should not only understand the importance of pathology but should champion advances that enable pathologists to be more engaged members of care teams. Decisions in cancer care depend on it.

 


 

1 Second Medical Opinion Often Leads To Alternative Treatment, Poll Finds. The Wall Street Journal Online. Updated Mar 15 2005. http://online.wsj.com/news/articles/SB111081698018978704. Accessed Sept 2014.

2 Cancer. Fact Sheet No297. World Health Organization. Updated Feb 2014. http://www.who.int/mediacentre/factsheets/fs297/en/. Accessed Sept 2014.

3 FastStats: Leading Causes of Death. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.  Accessed Sept 2014.

4 The Global Economic Cancer Burden. World Cancer Research Foundation. http://www.wcrf.org/PDfs/WCD-2013-The-Global-Economic-Cancer-Burden.pdf. Accessed Sept 2014.

5 2013 Pathology Workforce Summit. College of American Pathologists. http://www.cap.org/apps/docs/statline/pdf/pathology_workforce_summit_propositions.pdf. Accessed Sept 2014.


One thought on “Pathology: A Key Link in the Cancer Care Cycle

  1. Extraordinarily well written and articulated Curtis, nice work. The role of the pathologist is an opportunity and lever to improve care, quality, patient satisfaction, and productivity.

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